What is erectile dysfunction?
ED is an inability to get and / or keep an erection that allows sexual activity with penetration. It is not a disease, but a symptom of some other problem, either physical, psychological or a mixture of both.
ED should not be confused with low libido (little interest in sex) or the inability to reach an orgasm or ejaculate. Premature (too early) and retrograde ejaculation (into the bladder) are also different problems which require a different approach to diagnosis and treatment.
Occasional ED is normal. There is no need to worry about the occasional failure to get or keep an erection. Some of the causes of occasional ED include excessive intake of alcohol, anxiety and tiredness. One of the most common causes of ED is middle aged men is lack of sleep.
How common is ED?
ED is very common and becomes even more common in older men. 52% of men over 40 years will suffer from ED. With each decade of age, the chance of having erectile problems increases.
How does an erection happen?
At a superficial level, getting an erection is a simple process. There are two tubes of spongy tissue that run along the length of the penis and this spongy material is surrounded by a tough fibrous, partially elastic covering.
A message is sent through nerves that leave the lower spinal cord, telling the blood vessels entering the spongy tissue of the penis to let more blood in. The flow of blood out of the penis is then blocked off so that the penis fills with blood and stretches within the outer casing. This creates an erection.
Underlying this relatively simple explanation is a very complex range of chemicals in the body that also work together to get the erection. At any one time, the muscle cells in the spongy tissue and in the blood vessels are influenced by a balance of chemical factors, some which cause an erection and some which encourage a flaccid (soft) penis.
What causes erectile dysfunction?
Many factors can interfere with getting an erection and often two or three factors are present at one time. In other instances there appears to be no obvious cause for the erectile dysfunction; however, most cases of erectile dysfunction are physical in origin.
There are many diseases that interfere with the functioning of the penis by either reducing blood flow or affecting the nerves. Some of these diseases include heart and blood vessel diseases, diabetes, multiple sclerosis and alcoholism. When the ED is caused by a physical illness it usually develops slowly. Some prescription drugs, such as antidepressants and blood pressure medication can cause ED as a side effect.
One in 10 cases of ED is caused by psychological factors. A man's sex drive (libido) can be affected by stress such as problems at work or financial worries. Feeling depressed and anxious about poor sexual performance can also lead to ED.
Known causes of ED include:
- Performance anxiety
- Sexual attitudes and upbringing
- Relationship problems
- Employment and financial pressures
- Psychiatric disorders
Serious health (metabolic) problems:
- High blood pressure
- Chronic renal failure
- High cholesterol
- Sleep apnoea
Reduced blood flow:
- Atherosclerosis (narrowing of the arteries)
Interference by medication, alcohol and other drugs
- Alcohol and drugs abuse
- Drugs used to treat;
- Blood pressure
- Psychiatric disorders
- Prostate cancer
Interference with nerve function:
- Parkinson's Disease
- Alzheimer's Disease
- Spinal cord trauma
- Multiple Sclerosis
- Diabetic neuropathy
- Pelvic surgery (prostate, bowel)
- Peyronie's disease
- Pelvic trauma
Is ED a part of getting old?
There is no doubt that the ageing penis has less responsive muscle cells, which interfere with good erections. Like the rest of the ageing body, muscle tone in the penis reduces with age, as do many other aspects of sexual function. It can take longer for a man to get fully aroused. It may take much longer before a second erection happens, compared to the experience when young and usually the erection is not as firm.
Where can help be found?
When a man experiences erectile dysfunction he should see his local doctor, whether or not he wants to have sex. The reason for this is that ED may be symptoms of underlying medical conditions such as diabetes or heart disease. It is important to talk openly to a doctor about any problems with sexual functioning.
Diagnosis of ED does not require complicated tests. After taking a history of sexual function and general medical factors, the doctor will do a physical examination of the penis, testes and prostate. Blood tests are done to check glucose (sugar levels), cholesterol and testosterone levels.
How is ED treated?
Usually there will not be a specific treatment that will lead to the cure of ED. However, there are treatments that will allow erections to happen and can be used to enable sexual activity to take place. The main types of treatment for ED are:
There are tablets (Viagra ®, Cialis ® and Levitra ®) which work in 70% of men with ED. These drugs, known as PDE5 inhibitors, inhibit a particular enzyme in the penis, enhancing the erectile response to normal sexual stimulation. Taking a tablet for ED is non - invasive and does not cramp the spontaneity of lovemaking.
A vacuum device is a pump placed over the penis to create blood flow. It draws blood into specific tissues of the penis, mimicking a normal erection.
There are medications which increase blood flow when they are injected into the penis. One of the side effects is a painful erection lasting for hours, known as "priapism".
Hormone therapy is only suitable for men whose levels of sex hormone, such as testosterone, are too low. It is not a common cause of erectile problems.
In consultation with your doctor, changing your prescription drugs if they are the cause.
Penile prosthetic implants:
Penile prosthetic implants are usually used as a last resort if all other treatments have not worked.
It is usual to start with the least invasive treatment, such as tablets and to recommend more complicated injection treatments or surgery if the tablets fail.
Can ED be prevented?
At the present time there are no proven ways to prevent erectile problems developing, however keeping general good health may help lower the chance of having these problems.
Heart disease and diabetes can cause ED so preventing both of these problems through lifestyle changes, such as sensible eating and exercise habits, may greatly reduce the likelihood of developing ED.
Does seeing a counsellor?
Psychosocial problems are important and may cause ED in their own right, or together with one of the other causes listed above. Relationships are complicated and many factors cause tensions, which can affect sexual relations. In some men, problems can become ongoing and it can help to talk through the issue with a skilled counselor. Improved sexual function may be delayed by failing to deal with the psychological side. Being open and honest with your partner will encourage a good understanding of the problem and couples can work together to bring about a positive result to their relationship.